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FOR OFFICE 5E: - <br /> APPLICATION FOR SANITATION PERMIT Permit No. . .......... -...... <br /> ------------------------------- (Complete in Duplicate) Date Issued ...... <br />----------------------------� � � Jif <br /> This Permit Expires 1 Year From Date Issued .........r... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. S49. <br /> JOB ADDRESS AND LOCATIQN__-_ --- ----------G.�,r•.----_ <br /> �v ---------- ----------------------------------•-•------------------- <br /> JOB ADDRESS AND LOCA <br /> Owner's Name-------- P = ......... -----• ------- Phone 477- ------- <br /> Address_ � <br /> Contractor's Name................... . ..r��. .... ------ -- -- ---- -----------------------•.............._..-------------- Phone,&�.Qti<,��..... <br /> Installation will serve: Residence ❑ Apartment House I—] Commercial [3 Trailer ( - <br /> Number <br /> ❑ Other [3Number of living units: .....--. Number of bedrooms --- ---- Number of baths -----.-. Lot size ..� <br /> _.moi._:�<..Pie9.lf....----•------------------- <br /> Water Supply: Public system V Community system El Private E] Depth ro Water Table $/A ft. <br /> Character of soii to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 5' Hardpan ❑ <br /> Previous Application Made: -(If yes,date--------- ----------) No ❑ New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND' SPECIFICATIONS: } <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-1 1__Distance;rom foundation._/��_.___.Ma�rj�l ~___ ______ ______________________ <br /> No. of compartments_.._________________Size___ 1 -/07_Liquid depth-!�,�_____-___-.-Capacity." <br /> spo Field: Distance from nearest well-----------------Distance from foundation..............._.__-Distance to nearest lot line.....__.---_-.- <br /> + Number of lines---:---•---------------------------Length of each line---------------------. ------Width of french----------------------------------- <br /> Type of filter material.-------r------_'----_--Depth'of filter material________________-------Total length---.._.•--------.......................... <br /> Distance to nearest well----..___-_-_--.--_ <br /> __Distance,from foundation____________________Distance to nearest lot line____.__..._.___.. <br /> Number of pits-------------------[-Lining material-----------------------Size: Diameter---------------------- Depth-------.--.----------•------• -- . <br /> Cesspool: Distance from nearest well_________________Distance from foundation---------------- ...Lining material----------------- _:__-----_---___-- <br /> ❑ � l *Size: Diameter--------------------- -De th------ " Li uid Ca acitY si <br /> Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest;building-.---.-__-___-_---_-_-_--___--_-___----._. <br /> ❑ Distance to nearest lot line---------------------------------- i <br /> --......-=w----.•-------------- ------------------------------V, <br /> ] -.—J- r ------ F <br /> Remodeling and/or repairing (describe ---- ------ ------------ ------- --------------- •r'�fP' .-=-- ---•--- ...... -••---• , <br /> F <br /> 3 w <br /> R <br /> + S <br /> ----------------------- ---------------------------••_-----____-_---.---------------------------------------------------------------------------­----------------------------------------------------- ___-.-.-.-. .. <br /> heF. t <br /> rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance laws, and rules and r ulations of the San Joaquin Local Health Di�rict. ,g.- -- -------------------------•_--__-- _-- AX— <br /> BY: <br /> Owner and or Contractor(Signed} - ( / <br /> ------------------------------------------ _ Title <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc:, can be placed on reverse side). <br /> R DEPARTMENT USE ONLY <br /> z ` r 3 <br /> APPLICATION ACCEPTED BY--------- -- -------F-----r'+--�.---- ---------------•-----------•----•---------------._.. DATE----�- ---------------- <br /> ••------ <br /> REVIEWED BY--------•-----------------•----------------- --------------------------------- ---------------------------------------------- DATE------------------------------------------- <br /> i7---------: I <br /> BUILDING <br /> --------- <br /> BUILDING PERMIT ISSUED----------------------------- <br /> Alterations and/or recommendations----------------- ------------ ------------------------------------------------------------------------------------ --------.__..------------------------------ <br /> --------------------------- ---.-----------------------•---------.-----••--•--------------------------------- -----------------•--•-•-----------.----.--.---•---------------•------------------------••--------........ <br /> i <br /> --•-•------------------------------------------------------ ------ - -----------------•----•----------------------------•----------------- <br /> FINAL INSPECTION BY:............ . . � ,� -cam._ Date---------------- __. _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street 1 <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-59 2M 5-52 ATLAS <br /> r <br />